A national nurses' strike could be on the cards after they voted to reject a pay offer from district health boards across the country.
The offer was for 27,000 nurses, hospital aides, and core midwives, to get a 2 per cent pay rise as well as a $1050 lump sum.
The New Zealand Nurses Organisation said after several weeks of meetings nationwide that DHB nurses, midwives and healthcare assistants who were party to the collective agreement talks had voted not to ratify the DHB employer offer.
NZNO industrial services manager Cee Payne said this meant negotiations with the DHB employer negotiating team had reached an impasse.
"The Employment Relations Authority requires us to continue to act in good faith with the DHB employers through this impasse. We remain open to any meaningful discussions with the DHB employer negotiating team," she said.
While industrial action was a last resort in the event bargaining could not be settled, the NZNO had decided a delegates committee would get together on April 18 to discuss the need for a ballot for industrial action.
"The nature of what industrial action might consist of will be decided then.
"We understand the impact that industrial action will impose on the health sector. Nurses are responsible and professional and will be concerned to ensure that adequate life-preserving services will be available should a strike occur."
If the strikes happened, it would likely be 24 hours of all nurses walking off the job, she said.
Meanwhile, NZNO had launched a campaign "#HealthNeedsNursing" and a website www.healthneedsnursing.nz.
The campaign called for nursing and midwifery teams to be paid fairly to ensure safe patient care and to ensure the right infrastructure is in place for public healthcare.
"Members in DHBs are under huge pressures and feel their work is undervalued in a context of a decade of severe underfunding," Ms Payne said.
She said there had been a decade of underfunding along with increasing community need for health care, an ageing population, ageing workforce and rising costs to deliver health care.
Over that 10 years she said nurses had dealt with increased workloads, stress, fatigue and lack of satisfaction.
An experienced nurse who has worked in Hawke's Bay but did not want to be named agreed.
"Over the years the exhaustion of increased workloads and demands have worn out lots of nurses - they are leaving in droves."
He said these issues had been brought up repeatedly over the years.
"I get sick and tired of explaining how nurses work - we are not manufacturers or self-employed businesspeople - we are there to care for others, not for the money, and even if we are exhausted we want to go back to work."
He predicted there would be no quick fix to the longstanding issue, but said a start would be to question why chief executives and other such staff kept getting big salary increases, while those on the ground didn't.
"These others are sucking the money out of this business of healthcare while the nurses keep going.
"The care has been taken out of healthcare - if we do not put that back quickly we will realise what we have done."
The Hawke's Bay DHB referred all inquiries to TAS, which provides strategic workforce services for DHBs.
Spokesman Mick Prior said the first response would be to talk to the union to try to organise a settlement.
If this is unsuccessful there is a process for contingency planning to ensure DHBs can maintain essential hospital services and keep disruption to a minimum.